Healthcare Provider Details

I. General information

NPI: 1477560514
Provider Name (Legal Business Name): SRA VENTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1193 BLACKWOOD AVE UNIT H
OCOEE FL
34761-4518
US

IV. Provider business mailing address

501 S LINCOLN AVE #15
CLEARWATER FL
33756-5945
US

V. Phone/Fax

Practice location:
  • Phone: 407-656-6040
  • Fax: 407-656-4431
Mailing address:
  • Phone: 727-446-6760
  • Fax: 727-441-2465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. ANTHONY ABOUD
Title or Position: CEO
Credential: DO
Phone: 727-446-6760